Publications by authors named "Joshua Crane"

4 Publications

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Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy.

Psychopharmacol Bull 2020 Oct;50(4 Suppl 1):142-162

Peck, MD, Noor, BS, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Crane, BS, McNally, BS, Georgetown University School of Medicine, Washington, DC. Patel, BS, University of Arizona College of Medicine-Phoenix, Phoenix, AZ. Cornett, MD, Louisiana State University Health Sciences, Department of Anesthesiology, New Orleans, LA. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE.

Purpose Of Review: This is a comprehensive literature review of the available for treatment of oral muscle relaxants for cerebral palsy (CP) and associated chronic pain. It briefly describes the background and etiology of pain in CP and proceeds to review and weigh the available evidence for treatment for muscle relaxants.

Recent Findings: CP is a permanent, chronic, non-progressive neuromuscular and neurocognitive disorder of motor dysfunction that is diagnosed in infancy and is frequently (62% of patients) accompanied by chronic or recurrent muscular pain. Treatment of pain is crucial, and focuses mostly on treatment of spasticity through non-interventional techniques, surgery and medical treatment. Botulinum toxin injections provide temporary denervation, at the cost of repeated needle sticks. More recently, the use of oral muscle relaxants has gained ground and more evidence are available to evaluate its efficacy. Common oral muscle relaxants include baclofen, dantrolene and diazepam. Baclofen is commonly prescribed for spasticity in CP; however, despite year-long experience, there is little evidence to support its use and evidence from controlled trials are mixed. Dantrolene has been used for 30 years, and very little current evidence exists to support its use. Its efficacy is usually impacted by non-adherence due to difficult dosing and side-effects. Diazepam, a commonly prescribed benzodiazepine carries risks of CNS depression as well as addiction and abuse. Evidence supporting its use is mostly dated, but more recent findings support short-term use for pain control as well as enabling non-pharmacological interventions that achieve long term benefit but would otherwise not be tolerated. More recent options include cyclobenzaprine and tizanidine. Cyclobenzaprine carries a more significant adverse events profile, including CNS sedation; it was found to be effective, possible as effective as diazepam, however, it is not currently FDA approved for CP-related spasticity and further evidence is required to support its use. Tizanidine was shown to be very effective in a handful of small studies.

Summary: Muscle relaxants are an important adjunct in CP therapy and are crucial in treatment of pain, as well as enabling participation in other forms of treatments. Evidence exist to support their use, however, it is not without risk and further research is required to highlight proper dosing, co-treatments and patient selection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901132PMC
October 2020

The Association Between the Mechanical Ventilator Pressures and Outcomes in a Cohort of Patients with Acute Respiratory Failure.

Clin Med Insights Circ Respir Pulm Med 2020 15;14:1179548420966246. Epub 2020 Oct 15.

Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Background: Pressures measured during mechanical ventilation provide important information about the respiratory system mechanics and can help predict outcomes.

Methods: The electronic medical records of patients hospitalized between 2010 and 2016 with sepsis who required mechanical ventilation were reviewed to collect demographic information, clinical information, management requirements, and outcomes, such as mortality, ICU length of stay, and hospital length of stay. Mechanical ventilation pressures were recorded on the second full day of hospitalization.

Results: This study included 312 adult patients. The mean age is 59.1 ± 16.3 years; 57.4% were men. The mean BMI was 29.3 ± 10.7. Some patients had pulmonary infections (46.2%), and some patients had extrapulmonary infections (34.9%). The overall mortality was 42.6%. In a multi-variable model that included age, gender, number of comorbidities, APACHE 2 score, and PaO/FiO ratio, peak pressure, plateau pressure, driving pressure, and PEEP all predicted mortality when entered into the model separately. There was an increase in peak pressure, plateau pressure, and driving pressure across BMI categories ranging from underweight to obese.

Conclusions: This study demonstrates that ventilator pressure measurements made early during the management of patients with acute respiratory failure requiring mechanical ventilation provide prognostic information regarding outcomes, including mortality. Patients with high mechanical ventilator pressures during the early course of their acute respiratory failure require more attention to identify reversible disease processes when possible. In addition, increased BMIs are associated with increased ventilator pressures, and this increases the complexity of the clinical evaluation in the management of obese patients.
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http://dx.doi.org/10.1177/1179548420966246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573745PMC
October 2020

Comparison of High Versus Low Eccentric-Based Resistance Training Frequencies on Short-Term Muscle Function Adaptations.

J Strength Cond Res 2020 Jan 28. Epub 2020 Jan 28.

Kinesiology and Health Science Department, Utah State University, Logan, Utah.

Crane, JS, Thompson, BJ, Harrell, DC, Bressel, E, and Heath, EM. Comparison of high versus low eccentric-based resistance training frequencies on short-term muscle function adaptations. J Strength Cond Res XX(X): 000-000, 2020-Eccentric resistance training is beneficial for improving a number of performance and health metrics. However, the recommendations on eccentric training frequency have not been established. This study investigates the effects of volume-matched resistance training frequency comparing 1 vs. 3 training days per week of isokinetic multiple-joint eccentric training on strength and lower-body function adaptations during a 4-week training period. Thirty subjects were assigned to either 3 days per week (high-frequency [HF]) or 1 day per week (low-frequency [LF]) training conditions for 4 weeks. An eccentric dynamometer was used for the training and testing. Eccentric strength and vertical jump (VJ) measures were taken at Pre, Mid (2 weeks), and Post (4 weeks) intervention. Soreness (visual analog scale [VAS]) and rate of perceived exertion (RPE) were taken throughout the training period. There was no group × trial interaction for eccentric strength (p = 0.06) or VJ (p = 0.87). For eccentric strength, all trials were significantly different (p < 0.001) from each other. For VJ, there was a main effect for trial such that VJ increased from Pre to Post (p < 0.001) and Mid to Post (p < 0.01). High frequency reported lower RPE (p < 0.01) and soreness (p = 0.04) compared with LF. Both HF and LF protocols elicited large (36.8 and 27.4% strength increases, respectively) and rapid neuromuscular adaptations for improved strength. Eccentric-based workload may be dispersed across a given period to allow for reduced soreness and perceived exertion levels without compromising neuromuscular adaptations. Some eccentric training transfer to functional (VJ) task may also be observed, independent of training frequency.
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http://dx.doi.org/10.1519/JSC.0000000000003482DOI Listing
January 2020

Effects of isokinetic eccentric versus traditional lower body resistance training on muscle function: examining a multiple-joint short-term training model.

Appl Physiol Nutr Metab 2019 Feb 10;44(2):118-126. Epub 2018 Jul 10.

a Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA.

Early adaptations in eccentric training show several advantages over those in concentric training. The purpose of this study was to quantify the effects of 4 weeks of multiple-joint eccentric versus traditional leg press (TLP) training on muscle strength, rate of torque development (RTD), and jump and sprint performance adaptations. Twenty-six resistance-trained adults performed either an eccentric or a TLP resistance-training program twice per week for 4 weeks. Single-joint isometric maximal and rapid strength (peak torque and RTD, respectively) and isokinetic strength of the knee extensors and flexors, multiple-joint eccentric strength, leg press strength (1-repetition maximum), 40-m sprint, and vertical and long jump were measured before, at the midpoint, and after a 4-week training period. Four weeks of isokinetic multiple-joint eccentric training elicited greater test-specific strength gains (effect size (ES) = 1.06) compared with TLP training (ES = 0.11). The eccentric group also yielded moderate improvements in the middle-late phase RTD (RTD100-200; ES = 0.51 and 0.54 for the knee flexors and extensors, respectively), whereas the TLP group showed small-moderate improvements (ES = 0.37). The majority of the single-joint strength variables showed negligible improvements. Performance tests showed no (broad jump) to small (vertical jump; sprint for the leg press) improvements. Multiple-joint eccentric training induced significant improvements in lower body strength in a short amount of time in a recreationally trained population. These accelerated adaptations along with the lower energy requirements of eccentric exercise, may be useful for clinicians or practitioners when prescribing training programs for those who are injured, sedentary, or elderly as a means to elicit time- and metabolically efficient muscle function improvements.
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http://dx.doi.org/10.1139/apnm-2018-0333DOI Listing
February 2019